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Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs
that interventions directed at improving patient knowledge, skills, and confidence in managing the illness improve outcomes (Chodosh et al., 2005). One of the best-studied illness self-management programs, found effective in randomized controlled trials, is the Chronic Disease Self-Management Program developed and offered by Stanford University School of Medicine (Stanford University School of Medicine, 2007). Self-management programs for a variety of chronic illnesses based on this model have been found to be effective in reducing pain and disability, lessening fatigue, decreasing needed visits to physicians and emergency rooms, and increasing self-reported energy and health for a variety of chronic illnesses, including heart disease, lung disease, stroke, and arthritis (Lorig et al., 2001; Bodenheimer et al., 2002; Lorig and Holman, 2003).5,6
The term “illness self-management” is most often associated with conditions such as diabetes mellitus for which lifestyle changes can significantly affect the severity and progression of the disease. For this reason, it might be thought that self-management may not apply to cancer care. The committee believes this would be an overly restrictive view of self-management behaviors. In the cancer care literature, many interventions have been designed to assist patients in coping with the various challenges presented by the illness and its treatment, such as physical symptoms (e.g., fatigue or nausea), psychological distress, sexual dysfunction, and interaction with multiple providers. These interventions share a common premise with self-management interventions for other chronic conditions—that patients (and their families) have a major role to play in addressing or managing these challenges, and their ability to fulfill this role competently can be improved by information, empowerment, and other support.
Self-management and self-care interventions aimed at improving physical function and quality of life in cancer patients have typically focused on the control of individual symptoms and generally have been individually administered by nurses, whereas self-management interventions in patients with conditions other than cancer have more often been conducted in groups. A limited number of interventions have targeted control of nausea (Winningham and MacVicar, 1988), fatigue (Dimeo et al., 1999,
Stanford’s model also is a required component of the Administration on Aging’s public–private collaborative grant program for states and local communities, Empowering Older People to Take More Control of Their Health Through Evidence-Based Prevention Programs.
Although many individuals with cancer have participated in the Stanford model of illness self-management through 700 “master trainers” in the United States and worldwide, the University of Louisiana Brown Cancer Center also held two workshops targeting cancer survivors that followed the Stanford model, and identified no areas needing modification for this group (Personal communication. Karen S. Newton, MPH, RD, Project Director, Chronic Illness Initiatives, University of Louisville Department of Family and Geriatric Medicine via Kate Lorig, RN, DrPH, Stanford Patient Education Research Center, September 5, 2006).